Outcome characteristics of multiple-valve surgery: Comparison with single-valve procedures

Christina M. Vassileva, Shuang Li, Vinod H. Thourani, Rakesh M. Suri, Matthew L. Williams, Richard Lee, J. Scott Rankin

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE: Multiple-valve (MUV) procedures currently exhibit higher operative mortality than do single-valve procedures, but a paucity of scientific information exists to explain the observation. This topic was examined using The Society of Thoracic Surgeons Database. METHODS: All patients in the The Society of Thoracic Surgeons data set undergoing valve surgery (except pulmonary valve and aortic root operations) from 1993 through 2007 were identified (N = 623,039). Baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and MUV procedures involving aortic, mitral, and tricuspid valves. Seven independent logistic regression analyses were performed, based on the seven procedures, and multivariable risk factors for mortality were compared, with emphasis on single-valve versus MUV procedures. RESULTS: Baseline characteristics for MUV procedures (n = 67,926) shared many similarities to those for single-valve procedures (n = 555,113), including age, ejection fraction, and comorbidities. Preoperative renal failure, New York Heart Association class III to IV, nonelective presentation, and reoperation were slightly more common in MUV subsets, and coronary bypass was less frequent. Operative mortality was almost double for MUV as compared with single-valve procedures (10.7% vs 5.7%, P = 0.0001). Categorical predictors with the largest odds ratios for mortality were emergency status, renal failure, and second reoperation. However, predictors for mortality were generally consistent in order and magnitude between the single-valve and MUV subgroups. CONCLUSIONS: Despite similarities in preoperative profiles of the patients undergoing single-valve and MUV procedures, mortality for MUV surgery remains considerably higher. Determinants of operative mortality and morbidity differ little across the procedural groups, and these findings serve as a benchmark for future studies, as well as suggest a continued search for explanations of poorer MUV outcomes.

Original languageEnglish (US)
Pages (from-to)27-32
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Mortality
Reoperation
Renal Insufficiency
Benchmarking
Pulmonary Valve
Tricuspid Valve
Aortic Valve
Mitral Valve
Comorbidity
Emergencies
Logistic Models
Odds Ratio
Regression Analysis
Observation
Databases
Morbidity

Keywords

  • Multiple valve outcomes
  • STS Database
  • Valve surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Outcome characteristics of multiple-valve surgery : Comparison with single-valve procedures. / Vassileva, Christina M.; Li, Shuang; Thourani, Vinod H.; Suri, Rakesh M.; Williams, Matthew L.; Lee, Richard; Rankin, J. Scott.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 9, No. 1, 01.01.2014, p. 27-32.

Research output: Contribution to journalArticle

Vassileva, Christina M. ; Li, Shuang ; Thourani, Vinod H. ; Suri, Rakesh M. ; Williams, Matthew L. ; Lee, Richard ; Rankin, J. Scott. / Outcome characteristics of multiple-valve surgery : Comparison with single-valve procedures. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2014 ; Vol. 9, No. 1. pp. 27-32.
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AU - Vassileva, Christina M.

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AU - Williams, Matthew L.

AU - Lee, Richard

AU - Rankin, J. Scott

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AB - OBJECTIVE: Multiple-valve (MUV) procedures currently exhibit higher operative mortality than do single-valve procedures, but a paucity of scientific information exists to explain the observation. This topic was examined using The Society of Thoracic Surgeons Database. METHODS: All patients in the The Society of Thoracic Surgeons data set undergoing valve surgery (except pulmonary valve and aortic root operations) from 1993 through 2007 were identified (N = 623,039). Baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and MUV procedures involving aortic, mitral, and tricuspid valves. Seven independent logistic regression analyses were performed, based on the seven procedures, and multivariable risk factors for mortality were compared, with emphasis on single-valve versus MUV procedures. RESULTS: Baseline characteristics for MUV procedures (n = 67,926) shared many similarities to those for single-valve procedures (n = 555,113), including age, ejection fraction, and comorbidities. Preoperative renal failure, New York Heart Association class III to IV, nonelective presentation, and reoperation were slightly more common in MUV subsets, and coronary bypass was less frequent. Operative mortality was almost double for MUV as compared with single-valve procedures (10.7% vs 5.7%, P = 0.0001). Categorical predictors with the largest odds ratios for mortality were emergency status, renal failure, and second reoperation. However, predictors for mortality were generally consistent in order and magnitude between the single-valve and MUV subgroups. CONCLUSIONS: Despite similarities in preoperative profiles of the patients undergoing single-valve and MUV procedures, mortality for MUV surgery remains considerably higher. Determinants of operative mortality and morbidity differ little across the procedural groups, and these findings serve as a benchmark for future studies, as well as suggest a continued search for explanations of poorer MUV outcomes.

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